Provider Demographics
NPI:1104888957
Name:SZYMANOWSKI, MICHELLE M (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:SZYMANOWSKI
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W FRYE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-275-8346
Practice Address - Street 1:2550 E GUADALUPE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-505-4475
Practice Address - Fax:480-505-4252
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7151363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ398083Medicaid
AZ398083Medicaid
AZZ164056Medicare PIN